Summary
The pathology of anal fistulas was studied in 300 patients and a simple classification is put forward. Two main types of fistula are recognized: intrasphincteric and extrasphincteric, according to the relation of the track to the external sphincter. All fistulas start as a central space infection which either remains confined to the intrasphincteric compartment or spreads extrasphincterically.
Intrasphincteric fistulas include both central and intersphincteric fistulas. The latter fistula, as well as the extrasphincteric, are either low or high according to the relation of the track to the levator plate.
The classification is simple and practical. It clearly demonstrates the precise anatomic position of fistulas as related to anal musculature so proper planning for the treatment can be safely achieved.
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References
Chiari H: Über die Nalen Divertikel der Rectumschleimhaut und Ihre Beziehung zu den Anal Fisteln. Wien Med Press 19: 1482, 1878
Eisenhammer S: The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet 103: 501, 1956
Eisenhammer S: A new approach to the anorectal fistulous abscess based on the high intermuscular lesion. Surg Gynecol Obstet 106: 595, 1958
Goligher JC: Surgery of the Anus, Rectum, and Colon. Ed 3, London, Balliere Tindall, 1975, pp 192, 211
Goligher JC, Ellis M, Pissidis A: A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectal abscesses and fistulas. Br J Surg 54: 977, 1967
Herrmann G, Desfosses L: Sur la muqueuse de la region cloacale du rectum. C R Acad Sci (Paris) 90: 1301, 1880
Hill MR, Shryock EH, ReBell FG: Role of the anal glands in the pathogenesis of anorectal disease. JAMA 121: 742, 1943
Lilius HG: Fistula-in-ano: An investigation of human foetal anal ducts and intramuscular glands and a clinical study of 150 patients. Acta Chir Scand Suppl 383, 1968, 88 pp
Lockhart-Mummery JP: Discussion on fistula-in-ano. Proc R Soc Med 22: 1331, 1929
Milligan ET, Morgan CN: Surgical anatomy of the anal canal with special reference to anorectal fistulae. Lancet 2: 1150, 1213, 1934
Parks AG: Pathogenesis and treatment of fistula-in-ano. Br Med J 1: 463, 1961
Parks AG, Gordon PH, Hardcastle JD: A classification of fistula-in-ano. Br J. Surg 63, 1, 1976
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. I. The external anal sphincter: A triple-loop system. Invest Urol 12: 412, 1975
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. II. Anatomy of the levator ani muscle with special reference to puborectalis. Invest Urol 13: 175, 1975
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. III. The longitudinal anal muscle: Anatomy and role in anal sphincter mechanism. Invest Urol 13: 271, 1976
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. IV. Anatomy of the perianal spaces. Invest Urol 13: 424, 1976
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. V. The rectal neck: Anatomy and function. Chir Gastroenterol 11: 319, 1977
Shafik A: A new concept of the anal sphincter mechanism and the physiology of defecation. VI. The central abscess: A new clinicopathologic entity in the genesis of anorectal suppuration. Dis Colon Rectum 22: 336, 1979
Steitzner F: Die Anorectalen Fisteln. Berlin, Springer-Verlag, 1959
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Shafik, A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Dis Colon Rectum 22, 408–414 (1979). https://doi.org/10.1007/BF02586911
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DOI: https://doi.org/10.1007/BF02586911